Participant Name *

First Name

Last Name

Gender *

Male

Female

Date of Birth *

MM

DD

YYYY

Contact Number *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Agree to Waiver of Liability *

I the undersigned, agree to indemnify and hold harmless International Martial Arts Open, its officers, directors, agents, volunteers, and employees (hereinafter collectively “IMOPEN”) from any loss, liability, and all claims for personal injury, property damage or wrongful death, and any damages resulting therefrom, that may arise out of, or in any way related to, my participation in activities involving IMOPEN and which is alleged to have resulted from my participation at this center. This agreement shall not apply to claims that for public policy reasons are not subject to waiver or release. I hereby give my dependents permission to participate in the activities indicated and in doing so, absolve IMOPEN from liability. I also grant full permission to any and all of the foregoing to use my name and any photographs, videos, or recordings for any publicity and promotion purposes without obligation or liability to me. I have read and agree to be bound by its terms.

I agree